Treatments for post-traumatic stress disorder

It's important to get treatment for PTSD. Treatments include psychological therapies, physical treatments (medication), and exercise, mindfulness and self-help strategies. Talk to your GP or mental health professional about the best treatment for you. Often a combination of treatments works best.

Treatments for post-traumatic stress disorder

It's important to get treatment for PTSD. Treatments include psychological therapies, physical treatments (medication), and exercise, mindfulness and self-help strategies. Talk to your GP or mental health professional about the best treatment for you. Often a combination of treatments works best.

Important things to know about getting treatments for PTSD

You need a thorough check from a health professional before treatment is prescribed.

Psychological therapies and medication are the most established ways to treat PTSD.

New evidence shows that exercise and mindfulness are very useful for PTSD. They can be used together with physical and psychological treatments.

Exercise helps other conditions that can occur with PTSD, like depression, anxiety, sleep problems, cardiovascular disease and obesity.

You can get better. Many people who have had PTSD have been able to seek help, return to work, and live active, fulfilling lives.

There are three broad categories of treatment for PTSD:

psychological treatments (talking therapies)

physical treatments (medications)

exercise, mindfulness and self-help.

Often, a combination of treatments works best.

Find the best treatment for you

Everybody has a different experience. Your symptoms, any co-conditions (like anxiety or depression), and your personal preferences will influence which treatments are best for you.Talk to your GP or mental health professional about the best treatment for you. Sometimes, a team will be involved in your care. It’s still important that one professional coordinates and has overall responsibility for your treatment.

Psychological treatments are sometimes called ‘talking therapies’. Talking therapies can help us change habits in the way we think, and help us cope better with life’s challenges.

Psychological treatments can be one-on-one interactions, group-based or online. Psychological treatments can help us address the reasons behind our PTSD, and also prevent it from returning.

The Black Dog Institute recommends the following psychological treatments for PTSD:

trauma-focused cognitive behavioural therapy (CBT)

eye movement desensitisation and reprocessing (EMDR).

Trauma-focused cognitive behavioural therapy

Cognitive behaviour therapy (CBT) aims to show us how our thinking affects our mood. CBT teaches us to think in a different way about life, perceived dangers, and stress. We can challenge our thinking patterns and reframe the way we think. We can also face stressors (rather than avoiding them) and learn ways to challenge them.

There is good evidence that trauma-focused CBT is effective at reducing the symptoms of PTSD. CBT is sometimes used together with ‘exposure therapy’ (or ‘behaviour therapy’) where we are exposed to fearful objects or situations over time.

CBT can:

be conducted by a trained therapist in one-on-one or small group therapy sessions

include 'homework' between sessions, sometimes in the form of online mental health programs that are discussed in the next session

require about 10 sessions with the number varying from person to person

help you look logically at the evidence for your negative or worrying thoughts and dangers, and to adjust the way you view them.

CBT is also successfully used in treating depression and anxiety.

When cognitive behavioural therapy is used for PTSD it has two main parts:

A cognitive component that challenges and modifies our distorted thoughts about the trauma, ourselves and the world around us that have arisen because of a traumatic experience.

A behavioural component where we confront the memory of the traumatic event or situation in a safe environment (imaginal exposure); exposing us gradually and repeatedly to the triggers of our fear and stress, until we’re no longer distressed by them.

What can I expect from trauma-focused CBT?

Trauma-focused CBT can involve:

learning about PTSD and psychology

taking part in exercises describing and imagining the traumatic event and its aftermath, and exploring the negative emotions that arise

completing homework that can help you make progress between sessions

recording your feelings and the symptoms you experience when you face situations that trigger stressful reminders of the event.

It’s important that the professional treating you has expertise in this area, and regularly reviews your progress. Ask them about their training in trauma-focused CBT.

How long does trauma-focused CBT take?

When talking about traumatic experiences and the feelings that may come up, it’s important to have enough time.

Trauma-focused CBT usually consists of 8 to 12 sessions of one or two hours. Sometimes treatment is extended or altered depending on your response.

CBT can be very beneficial for people of all ages who have PTSD.

CBT has been found to be one of the most effective treatments for PTSD. It can be used across all ages from children and adolescents to the elderly.

CBT is generally delivered by a trained psychologist. Make sure they have training in trauma-focused CBT.

Eye movement desensitisation and reprocessing (EMDR)

EMDR is a form of treatment for PTSD, developed in the late 1980s. EMDR is based around the idea that when PTSD occurs, strong emotions might interfere with how we process information, so that the trauma experience is stored in our mind in a different way from other memories.

Patients are asked to keep focusing on trauma-related thoughts, feelings, and sensations in the body while watching a therapist’s moving fingers. The process can be repeated many times. The attention to both things is thought to help with processing the traumatic event. EMDR can:

involve 8 to 12 sessions

have many aspects in common with trauma-focused CBT

be effective in treating PTSD, particularly in patients who find it hard to talk about their traumatic experience.

Cognitive processing therapy

Cognitive processing therapy is designed specifically for treating PTSD.

Cognitive processing therapy:

explores major post-traumatic issues of safety, trust, power and control, self-esteem and intimacy

encourages patients to identify unhelpful thoughts and beliefs (also called ‘stuck points’), and to challenge them and replace them with more helpful and rational alternatives

requires less exposure than imaginal exposure therapy, where patients may be asked to write about their traumatic experiences.

can also address other common PTSD symptoms of depression, anger and guilt.

e-Mental health tools (e-therapy) for PTSD

There is good evidence that e-mental health tools, delivered via the internet, can be very effective in treating anxiety and depression. We need more evidence about their effectiveness for PTSD. e-Mental health tools can be useful for people who are not comfortable with face-to-face therapy, who are living in remote areas, or who have limited access to treatment.

e-Mental health tools are often managed in conjunction with a mental health professional, and can be a helpful resource between visits.

e-Mental health tools for PTSD might involve:

PTSD education

symptom management

exposure

cognitive reappraisal

homework

prevention and resilience exercises.

Features of e-mental health programs

e-Mental health programs are online mental health treatments and support options. You can access them on the internet using your smartphone, tablet or computer.e-Mental health programs are:

available throughout Australia wherever there is an internet connection

are anonymous (although some require an email so materials can be sent to you)

can mostly be accessed without a referral

can be used in conjunction with the work you are doing with your GP, psychologist or counsellor

are self-paced

are free (or available for a minimal cost).

Recommended e-mental health programs

The e-mental health programs we recommend have been researched, developed and tested in Australia. They include:

THISWAYUP

Experts at St Vincent’s Hospital Sydney developed the THISWAYUP e-mental health programs. It includes an online PTSD treatment course for people who’ve been feeling symptoms for more than four weeks after a traumatic event.

myCompass

The Black Dog Institute developed the myCompass program as an interactive self-help service to promote resilience and wellbeing for all Australians.

Other psychological treatments for PTSD

There are other psychological treatments that have been used to treat PTSD. However, there is less research or evidence about how effective they may be.

Not everyone with PTSD will need medication. However, certain types of medication can help a lot in some cases. Trauma-focused cognitive behaviour therapy (CBT) and eye movement desensitisation and reprocessing (EMDR) are the recommended first choice treatments for PTSD.

Other antidepressants that may be used include the serotonin-noradrenaline reuptake inhibitors (SNRIs) and the noradrenergic and specific serotonergic antidepressants (NaSSAs). The SSRIs, SNRIs and NaSSAs are better tolerated than older types of antidepressants.

Each medication can have side effects, and your health practitioner needs to carefully consider your individual needs. Medication works differently for everyone, so it’s important to discuss any changes, side effects or issues with getting better with your doctor.

Antidepressants can take a few weeks to work. It's important to discuss with your doctor how long you need to take them for (usually about 12 months), and when you can stop taking them. Stopping medication should be gradual with the dose being reduced over about four weeks. Stopping medication should be supervised by your doctor. Do not suddenly stop taking them.

Treatment of PTSD when there are other problems

Often, people with PTSD will also be experiencing one or more other conditions at the same time. When planning your treatment, your health professional needs to consider any other mental health conditions you may be experiencing, like depression and anxiety. PTSD can occur with other problems like:

depression

anxiety

suicidal thoughts

anger and hostility

drug and alcohol abuse

work absence due to sickness.

People with PTSD may also experience higher levels of:

obesity

chronic pain

diabetes

cardiovascular disease.

Australian information suggests that 85% of men and 80% of women with PTSD have another health condition along with PTSD.

Having other health conditions can affect your treatment

Your doctor should also assess your general health, check for chronic pain, and consider lifestyle conditions like diabetes and heart disease.

Medication is sometimes used when there are co-conditions with PTSD, such as depression, that may need medication, or when psychological therapies are unavailable or are not beneficial.

Other physical treatments for PTSD

Acupuncture

Acupuncture may be used as an additional treatment for PTSD for people who have not responded to trauma-focused psychological therapy, medication or exercise.

Acupuncture is part of traditional Chinese medicine. It involves placing thin needles into points in the patient’s skin to stimulate points that are believed to correct imbalances in the flow of energy through channels known as meridians.

Acupuncture is safe when administered by well-trained practitioners using sterile needles. It has a low risk of serious adverse effects.

We need more studies to show how effective acupuncture is in treating PTSD.

Repeated transcranial magnetic stimulation (rTMS)

rTMS is a relatively new treatment. It has had positive results in treating depression and is now being considered for treating PTSD.

The treatment involves placing an electromagnetic coil on the side of the head and applying a pulsing high intensity current through the coil.

rTMS is a pain-free, non-invasive technique for stimulating cortical neurons which may assist in reducing the symptoms of various conditions.

Mindfulness-based stress reduction can teach us how to be in the present moment in a non-judgmental, accepting way. There is increasing interest in how mindfulness can help PTSD.

A recent study of veterans with PTSD showed that 8 weeks of 2.5-hour group sessions of mindfulness-based stress reduction therapy significantly improved PTSD symptoms after 2 months. The therapy was provided in addition to the usual care methods.

Specialists are working on developing more well designed, best-practice mindfulness and exercise programs that can be used in addition to usual care treatments for PTSD.

What does mindfulness involve?

We all have the capacity to be mindful. Mindfulness involves:

cultivating our ability to pay attention in the present moment

disengaging from mental ‘clutter’ to have a clear mind

making it possible to respond rather than react to situations

improving our decision-making and potential for physical and mental relaxation.

Mindfulness has been found to have considerable health benefits.

How can I access mindfulness-based cognitive therapy?

Mindfulness-based cognitive therapy is usually undertaken as an 8-week group program. Sometimes psychologists use this technique in one-on-one therapy sessions.

You can also practice mindfulness at home and in everyday life. See the Black Dog Institute’s Mindfulness in everyday life handout for tips and techniques on how to use mindfulness. There are also many good mindfulness apps.

Further reading for health professionals

Doctors from the Black Dog Institute and UNSW are looking into how exercise can assist recovery from PTSD.

Trials show very good evidence that when undertaken together with the usual PTSD care (CBT, EMDR, group therapy or medication) structured exercise, in the form of resistance training and walking, improves symptoms for people with PTSD.

One trial involved a 12-week program of 3 x 30-minute resistance training sessions each week and a walking program, in addition to the usual care of psychotherapy, pharmaceutical and group therapy. The results demonstrated clear benefits of exercise with reduced PTSD symptoms, reduced depression, and improved sleep.

Exercise also helps other conditions that occur with PTSD

It’s clearly established that exercise helps improve other conditions that occur with PTSD, such as:

depression

anxiety

sleep problems

obesity.

Exercise can also be viewed as a mindfulness activity, where you can aim to be in the present moment, without judgment. It’s also something positive you can do to help yourself.

More research is needed into the effect of physical and exercise-based interventions on PTSD.

Group therapy is a means of delivering PTSD treatment. While we still need more research in this area, attending well managed group cognitive behavioural therapy (CBT) can be an effective way to get help for PTSD.

Well conducted groups can also provide other benefits including:

peer support

knowing PTSD happens to others after trauma, and they share similar feelings

hearing positive stories of other people’s recovery, and ways you can recover.

It’s best that any prolonged exposure component of therapy occurs in an individual face-to-face session rather than in group therapy. Progressive engagement with exposure tasks need to be monitored and adjusted to maximise recovery.

Other types of group therapy include supportive and psychodynamic approaches.

Relaxation techniques

Relaxation techniques can involve gradual and deliberate muscle relaxation, visualising a calm place, and breathing techniques. These techniques may help our anxiety by assisting us in ‘unclenching’ and relaxing our muscles, and breaking the cycle of nervous and anxious thoughts.

Studies show that relaxation techniques are effective for many anxiety related mental health problems.

Although relaxation therapies can be helpful for some people, studies suggest that they are not as helpful as trauma-focused therapies, such as CBT and EMDR for PTSD.

You can teach yourself relaxation techniques by looking online, or by seeing a professional. See our handout on relaxation techniques.

Yoga

Yoga is an ancient Indian exercise philosophy that provides a gentle form of exercise and stress management. It consists of postures or 'asanas' that are held for a period of time and are often synchronised with the breathing.

Yoga is very helpful for reducing stress and anxiety. More studies are being done into how it can help with PTSD.

Yoga can help through:

calming the anxious ‘flight or fight’ response

distracting from the cycle of worrying thought patterns

producing endorphins

mastering new techniques and building self-esteem.

A number of studies have shown that yoga breathing exercises are beneficial for anxiety and depression.

The treatments might even involve safely going to places or situations that ‘trigger’ stress or slow exposure to these situations, until you are no longer distressed by them. Your health professional should help you manage any distress you feel as you challenge these memories and situations.

Your health professional should give you information about practical help and support.

They should tailor your treatment for your individual condition, and work together with you, your family, and other health professionals to help recovery.

You should feel very safe and comfortable with your health professional.

What are the goals of PTSD treatment?

Your health professional should outline realistic goals for your treatment.

We’re all different, and treatment should be tailored for each patient. The American Psychiatric Association gives five categories of goals when treating PTSD:

Reduction in severity of PTSD symptoms

Prevention/reduction in other trauma related conditions

Improvement in personal, social, work functioning

Relapse prevention

Coming to terms with the danger experienced regarding risk, safety and protection.

Treatment can be painful and you need to work hard. It’s challenging to deal with our distressed feelings and memories when we’ve been through trauma. Remember that with effective treatment, you can get better.

When you see your GP or other health professional, it’s important they make a thorough check of your health.Things they might ask about:

any history of other trauma

past experience of PTSD or other mental health conditions like depression or anxiety

your physical health

any substance use like drugs and alcohol

how you’re going at work, with family, and socially

any previous treatment

time since the traumatic event/s.

Your GP will probably ask you some initial screening questions to check on whether you might have PTSD or another mental health condition. You will not be required to give too much detail of the trauma initially, just a brief description of the type of event that you experienced.

If you have treatment, it’s very important to check in with your health professional so they can monitor your progress, and make any changes.

They may also refer you to another health professional. For example, your GP might refer you to a psychologist. You should feel comfortable talking to your health professionals and confident in their ability to treat you.

When someone you care about has been through a trauma, you might notice changes in their emotions and behaviour. They might become angry and irritable, or seem distant and down. They might even shut you out and stop doing things they used to enjoy.

PTSD can place a strain on family and carers

It’s upsetting when a loved one treats you this way. You might be extremely worried about their wellbeing and about seeing their distress. Remember that this behaviour is part of the symptoms of PTSD. It’s not because of you. If you’re finding things too hard, make sure you ask for help.

There are lots of things you can do to help someone with PTSD

Learn about PTSD - This can help you and your family understand what your loved one is going through and learn why it’s happening.

Listen - Encourage the person to tell you about their feelings. You don’t have to find solutions for them, that’s what a professional needs to do. If the details are too hard to hear about, let them know. Always reassure them that you care.

Spend time with them - Being supportive can include simple things like having a cup of tea, going for a walk, giving a hug. Understand they might also want some time alone.

Help find professional help - Offer to make appointments with a GP or other health professional. You might also be able to take them to appointments, and even attend them if they want you to.

Keep focused on recovery - Dealing with the trauma and getting better can be a long and complicated process. It involves facing painful memories and they might feel like stopping. Encourage them to keep going and acknowledge that getting better can be challenging. Comment on small positive changes you notice and keep them hopeful.

Plan positive experiences - Try to keep your loved one involved with family and friends, and activities they enjoy. Try to keep them social, do small things together as a family. Celebrate positive events like birthdays.

Look after yourself too - Supporting others through trauma can be exhausting and distressing too. Take care of yourself by staying active, eating well, and getting enough rest. Spend some time out with friends and reach out for help if you need to. Your GP can give you names of counsellors and other people in your community who can help.

When we go through a traumatic event, we can feel fear, anger, sadness, guilt or grief. Mostly, these feelings resolve on their own and with the support of our family and friends we gradually recover.

Here are some things that might help you come to terms with what’s happened. Always know you can ask for help if things are too hard.

Acknowledge what you’ve been through. You’ve just been through a terrifying, distressing event and reacting to it is normal. Remember your strengths. It’s tough but you can find ways to deal with it.

Take care of yourself. Get plenty of rest, even if it’s hard to sleep. Try to do some gentle exercise and eat well.

Minimise stimulants like coffee, tea, soft drinks and cigarettes.

Don’t use drugs or alcohol to cope. They may cause problems and make recovery harder.

Try to do something enjoyable and schedule it in. You could try making a plan for each day, include a bit of exercise, relaxation, and if you are up to it, some work.

Get back to routine when you can. Do things at a gentle pace and resume work if you can. Acknowledge each small achievement.

Don’t bury yourself in too much work or use work as an escape to block out painful memories.

Delay big decisions and unnecessary stress. Put off moving house or changing jobs in the weeks after a distressing event.

Making small decisions is good. Keep choosing what you’d like to eat, where you’d like to walk to, what to watch on TV. Making these small decisions can help you feel more in control of things.

Surround yourself with loved ones. Being with people you care about is important. You don’t have to talk at length about your experience. Having company can be comforting and stops you feeling too isolated.

Try to talk about your feelings. This can be hard, but it’s good to try. Find someone you think will listen and try to understand. Talking about things helps us heal and gain acceptance about what’s happened. There might be a PTSD support group or online group you could join.

If talking is hard, try writing about how you feel. Writing is a powerful form of self-expression. It can help us come to terms with events and make sense of things.

Avoid constant viewing of trauma scenes. You might wish to keep updated about the event you have been through on social media, TV and radio, but don’t look at it constantly.

Give yourself some time. Going through trauma can make us question everything. It can affect the way we see our relationships and what we want in life. Keep talking to supportive people.

You can always ask for help

If things aren’t getting better after a couple of weeks, or if you are overwhelmed and not coping at home or work, ask for help. Getting help is not a sign of weakness and it’s best to get help early.

Start by talking to your General Practitioner (GP). Your GP has good resources and knows other health professionals who can help too.

Phoenix Australia guidelines on psychological first aid

Whilst routine psychological debriefing is no longer recommended straight after a traumatic event, the Phoenix Guidelines, developed specifically for PTSD in Australia, recommends practical steps to help someone following a potentially traumatic event. Its aim is to assist our natural resilience and coping abilities.

Ways to help someone straight after a traumatic event include:

talking to the person/people in a compassionate and caring way.

making sure they’re safe and give them any physical and emotional support they need.

If people are distressed and overwhelmed, reassuring them and staying with them.

addressing any important immediate concerns.

giving them information about social supports and/or community services or services if they need to get help in future weeks.

giving them information about coping, including education about stress reactions and coping, like a brochure or website links.